Konstantinos Papadopoulos, Michael Chrissoheris, Dionysios Aravantinos, Ignatios Ikonomidis, Konstantinos Spargias, Mani A. Vannan
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The purpose of this study is to analyze the acute mitral annular dimensional changes following PASCAL implantation and correlate with long-term results.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>A retrospective analysis was conducted on 115 high-risk patients (mean age 76 ± 11 years) with moderate-to-severe and severe MR (grade 3.9 ± 0.3, EROA 49± 23 mm<sup>2</sup>, LV ejection fraction 47% ± 14%). All patients had elevated surgical risk scores (logistic EuroSCORE 23.6% ± 11.5%, EuroSCORE II 6.9% ± 5%, STS Score 5.5± 4.2). Intraprocedural transesophageal echocardiography (TOE) was post-analyzed using specialized software to assess mitral annular geometry.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>PASCAL effectively reduced MR (grade 3.9 ± 0.3 to 1.2 ± 0.5, <i>p </i>< 0.001) in all patients. Significant reductions in 3D annulus area (15 ± 4cm<sup>2</sup> to 13.9 ± 4cm<sup>2</sup>, 7.1% ± 9.9%, <i>p</i> <i>< </i>0.001) and perimeter (14 ± 1.7 cm to 13.5 ± 1.8 cm, 3.2% ± 5.9%, <i>p < </i>0.001) were observed in 77.4% of our cohort immediately after TEER. Anterior–posterior (AP) diameter showed greater reduction (4.1 ± 0.6 cm to 3.8 ± 0.6 cm, <i>p < </i>0.001, 6.3% ± 7.8%) compared to medial–lateral diameter (4.3 ± 0.5 cm to 4.2 ± 0.6 cm, <i>p < </i>0.001, 3.2% ± 8%), and these changes resulted in a more elliptic valve at the end of the procedure (ellipticity from 105% ± 8% to 109% ± 10%, <i>p = </i>0.001). The reduction of the annulus dimensions correlated with the residual MR at discharge (<i>p</i> = 0.001), while these patients also achieved optimal long-term echocardiographic results with mild MR (<i>p = </i>0.019).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>TEER with PASCAL acutely reduces mitral annular dimensions, favoring a more elliptic valve shape, particularly through AP diameter reduction. These changes correlate with sustained MR improvement.</p>\n </section>\n </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"42 9","pages":""},"PeriodicalIF":1.4000,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Acute Changes in Mitral Annular Geometry After Transcatheter Edge-to-Edge Repair With PASCAL\",\"authors\":\"Konstantinos Papadopoulos, Michael Chrissoheris, Dionysios Aravantinos, Ignatios Ikonomidis, Konstantinos Spargias, Mani A. Vannan\",\"doi\":\"10.1111/echo.70279\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>Transcatheter edge-to-edge mitral valve repair (TEER) is an effective and safe method for treating high-risk patients with severe mitral regurgitation (MR). 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引用次数: 0
摘要
背景经导管二尖瓣边缘到边缘修复术（TEER）是治疗严重二尖瓣反流（MR）高危患者的一种安全有效的方法。MitraClip（雅培血管公司）和PASCAL（爱德华兹生命科学公司）这两种已获批准的器械使用叶状近似来降低MR，也可能通过叶状张力影响环形尺寸。本研究的目的是分析PASCAL植入后急性二尖瓣环的尺寸变化及其与长期结果的相关性。方法回顾性分析115例中重度、重度MR（分级3.9±0.3,EROA 49±23 mm2，左室射血分数47%±14%）高危患者（平均年龄76±11岁）。所有患者手术风险评分均升高（logistic EuroSCORE 23.6%±11.5%,EuroSCORE II 6.9%±5%，STS评分5.5±4.2）。术中经食管超声心动图（TOE）分析后使用专门的软件评估二尖瓣环的几何形状。结果PASCAL有效降低了所有患者的MR（3.9±0.3至1.2±0.5级，p < 0.001）。在我们的队列中，77.4%的患者在TEER后立即观察到3D环面积（15±4cm2至13.9±4cm2, 7.1%±9.9%,p < 0.001）和周长（14±1.7 cm至13.5±1.8 cm, 3.2%±5.9%,p < 0.001）显著减少。与内侧外径（4.3±0.5 cm至4.2±0.6 cm, p < 0.001, 3.2%±8%）相比，前后径（AP）的缩小幅度更大（4.1±0.6 cm至3.8±0.6 cm, p < 0.001, 6.3%±7.8%），这些变化导致手术结束时瓣膜更椭圆形（椭圆度从105%±8%至109%±10%，p = 0.001）。环形尺寸的减小与出院时残余MR相关（p = 0.001），而这些患者在轻度MR时也获得了最佳的长期超声心动图结果（p = 0.019）。结论：采用PASCAL的TEER术可明显减小二尖瓣环的尺寸，使二尖瓣形状更偏向椭圆形，尤其是通过AP直径减小。这些变化与持续的MR改善相关。
Acute Changes in Mitral Annular Geometry After Transcatheter Edge-to-Edge Repair With PASCAL
Background
Transcatheter edge-to-edge mitral valve repair (TEER) is an effective and safe method for treating high-risk patients with severe mitral regurgitation (MR). Two approved devices, MitraClip (Abbott Vascular) and PASCAL (Edwards Lifesciences), use leaflet approximation to reduce MR and may also influence annular dimensions via leaflet tension. The purpose of this study is to analyze the acute mitral annular dimensional changes following PASCAL implantation and correlate with long-term results.
Methods
A retrospective analysis was conducted on 115 high-risk patients (mean age 76 ± 11 years) with moderate-to-severe and severe MR (grade 3.9 ± 0.3, EROA 49± 23 mm2, LV ejection fraction 47% ± 14%). All patients had elevated surgical risk scores (logistic EuroSCORE 23.6% ± 11.5%, EuroSCORE II 6.9% ± 5%, STS Score 5.5± 4.2). Intraprocedural transesophageal echocardiography (TOE) was post-analyzed using specialized software to assess mitral annular geometry.
Results
PASCAL effectively reduced MR (grade 3.9 ± 0.3 to 1.2 ± 0.5, p < 0.001) in all patients. Significant reductions in 3D annulus area (15 ± 4cm2 to 13.9 ± 4cm2, 7.1% ± 9.9%, p< 0.001) and perimeter (14 ± 1.7 cm to 13.5 ± 1.8 cm, 3.2% ± 5.9%, p < 0.001) were observed in 77.4% of our cohort immediately after TEER. Anterior–posterior (AP) diameter showed greater reduction (4.1 ± 0.6 cm to 3.8 ± 0.6 cm, p < 0.001, 6.3% ± 7.8%) compared to medial–lateral diameter (4.3 ± 0.5 cm to 4.2 ± 0.6 cm, p < 0.001, 3.2% ± 8%), and these changes resulted in a more elliptic valve at the end of the procedure (ellipticity from 105% ± 8% to 109% ± 10%, p = 0.001). The reduction of the annulus dimensions correlated with the residual MR at discharge (p = 0.001), while these patients also achieved optimal long-term echocardiographic results with mild MR (p = 0.019).
Conclusions
TEER with PASCAL acutely reduces mitral annular dimensions, favoring a more elliptic valve shape, particularly through AP diameter reduction. These changes correlate with sustained MR improvement.
期刊介绍：
Echocardiography: A Journal of Cardiovascular Ultrasound and Allied Techniques is the official publication of the International Society of Cardiovascular Ultrasound. Widely recognized for its comprehensive peer-reviewed articles, case studies, original research, and reviews by international authors. Echocardiography keeps its readership of echocardiographers, ultrasound specialists, and cardiologists well informed of the latest developments in the field.
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